Idiopathic intracranial hypertension

Objective: To determine the prevalence and nature of sinovenous obstruction in idiopathic intracranial hypertension (IIH) using auto-triggered elliptic-centric-ordered three-dimensional gadolinium-enhanced MR venography (ATECO MRV). Methods: In a prospective controlled study, 29 patients with established IIH as well as 59 control patients underwent ATECO MRV. In a randomized blinded fashion, three readers evaluated the images. Using a novel scoring system, each reader graded the degree of stenosis seen in the transverse and sigmoid sinuses of each patient. Results: There was excellent agreement across the three readers for application of the grading system. Substantial bilateral sinovenous stenoses were seen in 27 of 29 patients with IIH and in only 4 of 59 control patients. Conclusion: Using ATECO MRV and a novel grading system for quantifying sinovenous stenoses, the authors can identify IIH patients with sensitivity and specificity of 93%.

[1]  M. Bousser.  Cerebral venous thrombosis: diagnosis and management , 1999, Journal of Neurology.

[2]  H. Sugerman,et al.  Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri , 1997, Neurology.

[3]  M. R. Theobald,et al.  Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. , 2000, AJNR. American journal of neuroradiology.

[4]  J. Malm,et al.  CSF hydrodynamics in idiopathic intracranial hypertension , 1992, Neurology.

[5]  M. Brodsky,et al.  Magnetic resonance imaging in pseudotumor cerebri. , 1998, Ophthalmology.

[6]  V. Biousse,et al.  Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. , 1999, Neurology.

[7]  G. Parker,et al.  Endovascular treatment of cranial venous sinus obstruction resulting in pseudotumor syndrome. Report of three cases. , 2001, Journal of neurosurgery.

[8]  H. Rekate,et al.  Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies , 1996, Neurology.

[9]  G. Parker,et al.  Cranial venous outflow obstruction in the pseudotumour syndrome: incidence, nature and relevance , 2002, Journal of Clinical Neuroscience.

[10]  R. Bernstein,et al.  Uncommon Causes of Stroke , 2002 .

[11]  B. Tress,et al.  Manometry combined with cervical puncture in idiopathic intracranial hypertension , 2002, Neurology.

[12]  G. Davies-Jones,et al.  Potentially prothrombotic abnormalities of coagulation in benign intracranial hypertension. , 1997, Journal of neurology, neurosurgery, and psychiatry.

[13]  F. Ståhlberg,et al.  Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging , 2004, Neuroradiology.

[14]  R. Alberico,et al.  Cerebral venography: comparison of CT and MR projection venography. , 1997, AJR. American journal of roentgenology.

[15]  K. Digre,et al.  Idiopathic intracranial hypertension , 2002, Neurology.

[16]  J. Pickard,et al.  Venous sinus stenting for refractory benign intracranial hypertension , 2002, The Lancet.

[17]  P. T. Nguyen,et al.  MR of optic papilla protrusion in patients with high intracranial pressure. , 1996, AJNR. American journal of neuroradiology.

[18]  Abraham R Totah,et al.  Cerebral venous thrombosis and isolated intracranial hypertension without papilledema in CDH , 2001, Neurology.

[19]  Deborah I. Friedman,et al.  Diagnostic criteria for idiopathic intracranial hypertension , 2002, Neurology.

[20]  W. I. McDonald,et al.  MRI of the optic nerve in benign intracranial hypertension , 1996, Neuroradiology.

[21]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[22]  P. Karanjia,et al.  Computed tomography ventricular size has no predictive value in diagnosing pseudotumor cerebri , 1990, Neurology.

[23]  Graham A Wright,et al.  Intracranial venous system: gadolinium-enhanced three-dimensional MR venography with auto-triggered elliptic centric-ordered sequence--initial experience. , 2003, Radiology.

[24]  A. Mamourian,et al.  MR of giant arachnoid granulation, a normal variant presenting as a mass within the dural venous sinus. , 1995, AJNR. American journal of neuroradiology.

[25]  J. Fleiss,et al.  Statistical methods for rates and proportions , 1973 .

[26]  B. Tress,et al.  Cerebral venography and manometry in idiopathic intracranial hypertension , 1995, Neurology.